Daniel I. Garcia/Abbott Ave LLCt..
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the passage, defeat or modification of
any ordinance, resolution, action or decision of any commissioner; any action, decision, recommendation of the City Manager or any city board or
committee; or any action, decision or recommendation of any city personnel during the time period of the entire decision-making process on such
action, decision or recommendation that foreseeably will be heard or reviewed by the city commission, or a city board or committee. The term
8pecifiCally includes the principal as well as any employee engaged in lobbying activities. The term "Lobbyists" has specific exclusions. Please
afar to OMinance 2004.3435.
NAME OF LOBBYIST: (Last) (F~rst) (M.I)
BUSINESS NAME ANO ADDRESS (Number and Street) (City) (State) (Zip Code)
NUMBER: FAX NUMBER:
1. LOBBYIST RETAINED BY:
Ate; /,L L
NAME OF PRINCIPAUCLIENT:
1'~ P~ll~ ~ ~~ ~~
BUSINESS NAME AND ADDRESS Number and Street
( ) (City) (State) (Zip Code)
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST:
n.SPECIFIC LOBBY ISSUE:
lll. CITY AGENCIESIINDIVIDUALS TO BE LOBBIED: (Pursuant to city code section 2-4ttz(g)
include a statement of the extent of any business, tinancial, familial, professional or other relationship, giving raise to an
appearance of an impropriety, with any City personnel sought to be lobbied; further, pursuant to City Code Section 2-
4i2~a)(4) include a statement of any contractual relationship (paid or unpaid) from 12 months preceding the
comm~rrcement of service of City personnel to be lobbied.) -
A' Ful Name of Individual Title B) An Financial, Familial or Professional Relationship
~.
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER): ,
A) LOBBYIST DISCLOSURE: IRequired) f \b~
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required). ~~
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
present or pending award for goods equipment or service
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues":
Yes ~ No: Are you lobbving on a uendinq application for a Development Agreement with the C~tv or
application for change of zoning map designation or change to the Citv's Future Land Use
Man?
3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the definition of
"lobbyist" as set forth in Section 2-481 above) who only appears as a representative of anot-for-profit
corporation or entity without special compensation or reimbursement for the appearance, whether direct, or
indirect, to express support of or opposition to any item, shall register with the clerk as required by this
section but, shall not be required to pay any registration fees.
Yes ~ No: Are you representing anot-for-profit corporation or entity without special compensation or
reimbursement. .
V. SIGNATURE UNDER OATH:
Signature of Lobbyist:
,..~~~~..,, I ature of Principal/Client:
_..
LOBBYIST IDENTIFICATI
~~ ~* m,~ PRINCIPAL IDENTIFICATION:
„~on,y,
Produced ID $ i ~~
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Form of Identification
~ ~ _ Produced ID
Form of Identification ~s~
~
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~ 3
^ Personally known (Lobbyist)
^ P
ll 2O
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~ ersona
y known (Principal) 3
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S ~~ SIGNATURE AND STAMP OF NOTARY: 3
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N ~ of Florida, County of Miami-Dade
~ ~^!o to and subscribe before me State of Florida, County of Miami-Dade
Sworn and subscribed before ~ :n
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~
s
~~s ~"' day of ~~, 2008 me
This da
of
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Signature of Public Nota
ry -State f Florida
Notarization of Lobbyist's signature
Signature of Public Notary - Stat of Florid
N
'
otarization of Principal
s signature
TO E COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: ]Yes [ ) No Amount P id S /~
Lobbyist Registration Form received and verified by: MCR # Date Paid
F:\CLER\HATL\Form_ ,:.obbv <'. F.~-c -;~.-. ~,;.~; F~~ •,a.rtt•.: oo.,:wa n~ai~~ionno
I do solemnly swear that all o the foregsing facts are true and correct and that I have read or am familiar with the
provisions contained in Section -482~~e Miami Beach City Code and all reporting requirements.
1 r 1
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachFl.gov
CITY CIERK OfFice CiyClerk@miamibeachN.gov
Tel: 305.673.741 1 ,Fox: 305.673.7254
LOBBYIST NAME: ~~~~ ~ ~ ~ ' ~n~ G ~
I understand that no later than October 1st of each dear, I must file the following
Forms, pursuant to Section 2-485 of the Miami Beach City Code, with the City Clerk's
Office for all active lobbying issues.
1 ~ Lobbyist Expenditure Form
2) Disclosure Form
Failure to file these forms on a timely basis will result in my name being transmitted to the
Miami-Dade County Commission on Ethics and for code violation evaluation.
In addition, once an issue I have registered to lobby on has been resolved, I am required
to immediate notify the City Clerk's Office of lobbyist withdrawal in writing.
sign
~-('d~
Date:
I~wised 02/D4;200&